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Kazuyuki Kumagai,1 Nobuchika Ogino,2 Marie Fukami,1 Mariko Furukawa11Kami-iida Daiichi General Hospital, Aichi, Japan; 2Shinjo Ophthalmologic Institute, Miyazaki, JapanPurpose: To determine the long-term outcomes of vitrectomy for the macular edema associated with a retinal vein occlusion (RVO).Methods: This was a retrospective, consecutive, interventional case series. The intraoperative procedures included internal limiting membrane peeling, arteriovenous sheathotomy, radial optic neurotomy, and intravitreal triamcinolone acetonide injection at the end of the surgery. The main outcome was the best-corrected visual acuity (BCVA).Results: Eight hundred and fifty-four eyes of 854 patients were studied. The eyes consisted of 602 with branch RVO (BRVO), 74 with hemi-central RVO (hemi-CRVO), 87 with nonischemic central retinal vein occlusion (CRVO), and 91 with ischemic CRVO. The mean follow-up period was 68.6 months with a range of 12 to 262 months. The mean BCVA was significantly improved at the final visit (P

Kazuyuki Kumagai,1 Nobuchika Ogino,2 Marie Fukami,1 Mariko Furukawa1 1Kami-iida Daiichi General Hospital, Nagoya, Aichi, Japan; 2Shinjo Ophthalmologic Institute, Miyazaki, Japan Purpose: The purpose of this study was to determine the long-term outcomes of intravitreal bevacizumab (IVB) or intravitreal tissue plasminogen activator (tPA) or vitrectomy for macular edema associated with a branch retinal vein occlusion (BRVO).Methods: This was a retrospective, interventional case series. Forty-one patients received a single 1.25 mg of IVB injection and followed by pro re nata protocol, 71 patients received a single intravitreal tPA, and 116 patients underwent phacovitrectomy with intraocular lens implantation.Results: The baseline characteristics and follow-up periods were not significantly different among the three groups. The mean follow-up period was 55.5 months with a range of 12–160 months. Sixteen patients (39.0%) in the IVB group, 24 patients (33.8%) in the tPA group, and two patients (1.7%) in the vitrectomy group underwent additional surgeries during the follow-up period. The best-corrected visual acuity (BCVA) significantly improved in all groups at 1 year after the initial treatment (all, P

Kazuyuki Kumagai,1 Nobuchika Ogino,2 Mariko Furukawa,1 Rieko Ooya,1 Eiji Horie3 1Kamiiida Daiichi General Hospital, Nagoya, Japan; 2Nishigaki Eye Clinic, Nagoya, Japan; 3Yata Eye Clinic, Izunokuni, Japan Purpose: The aim of this study was to determine whether the centripetal displacement of the capillaries in the macular region after vitrectomy is caused by internal limiting membrane (ILM) peeling. Methods: Eighteen patients with different types of retinal diseases but with a normal or approximately normal foveal contour underwent successful vitrectomy with (n=12) or without (n=6) ILM peeling. Optical coherence tomography angiography (OCTA) images of the inner retinal vascular plexus in the macular region were analyzed pre- and postoperatively. Four concentric polygonal areas were marked in the OCTA images with the corners selected to be easily identified by vessel bifurcations. The areas of the postoperative foveal avascular zone (FAZ) and the four polygonal regions at about 1 month postoperatively were compared to the baseline areas. Results: Vitrectomy was performed for eleven eyes with vitreomacular tractions, three with macular-on retinal detachments, and four with thin epiretinal membranes. A significant decrease in the FAZ area was observed postoperatively in only the ILM-peeled eyes (P=0.0002). The four polygonal areas in the ILM-peeled eyes decreased after surgery, and the decrease was fit by a linear regression line (R2=0.985–0.999; n=7). The time course of the postoperative decrease of the FAZ area was fit by a hyperbolic curve (R2=0.969–0.998; n=6). The average postoperative time required to reach one-half of the final FAZ area was 1.16 days (0.81–1.62 days). Conclusion: These findings suggest that ILM peeling causes an early centripetal displacement of the capillaries in the macular region. Keywords: epiretinal membrane, foveal avascular zone, internal limiting membrane, macular hole, optical coherence tomography angiography

Takanori Mizoguchi,1 Mineo Ozaki,2 Nobuchika Ogino3 1Mizoguchi Eye Clinic, Ophthalmology, Sasebo, Japan; 2Ozaki Eye Hospital, Ophthalmology, Miyazaki, Japan; 3Nishigaki Eye Clinic, Ophthalmology, Nagoya, Japan Purpose: To evaluate the efficacy and safety of 0.05% epinastine and 0.1% olopatadine eye drop preparations as seasonal and preseasonal treatments in patients with seasonal allergic conjunctivitis (SAC). Subjects and methods: This was a prospective, randomized, case-control study involving two institutions. The subjects were patients diagnosed with SAC at two institutions between February and March in 2014. To examine the clinical effects of seasonal treatment, 0.05% epinastine and 0.1% olopatadine were administered, and their effects were investigated every 2 weeks (Stage 1). To evaluate the clinical effects of preseasonal therapy, in January 2015, the same eye drop preparations as adopted in Stage 1 were administered to patients who had participated in Stage 1 and provided consent to participate in this study, and their effects were investigated every month (Stage 2). Results: In Stage 1, the 0.05% epinastine group consisted of 43 patients, and the 0.1% olopatadine group consisted of 42 patients. There were significant improvements in the total symptom and objective finding scores at each time point after administration in comparison with those before its baseline, but there were no significant differences between the two groups. In Stage 2, the 0.05% epinastine group consisted of 15 patients, and the 0.1% olopatadine group consisted of 14 patients. The rate of change in the total symptom score in comparison with that at the baseline of preseasonal treatment was significantly higher in the 0.1% olopatadine group 1 month after the start of treatment, suggesting symptom deterioration (P=0.025). There was no significant difference in the rate of change in the total objective finding score between the two groups. Conclusion: Seasonal treatment with 0.05% epinastine or 0.1% olopatadine was equally effective for patients with allergic conjunctivitis. However, for preseasonal therapy, 0.05% epinastine was more effective than 0.1% olopatadine. Keywords: 0.05% epinastine, 0.1% olopatadine, seasonal allergic conjunctivitis, preseasonal treatment, seasonal treatment, inverse agonist

Kazuyuki Kumagai,1 Mariko Furukawa,1 Tetsuyuki Suetsugu,1 Nobuchika Ogino2 1Department of Ophthalmology, Kami-iida Daiichi General Hospital, 2Department of Ophthalmology, Nishigaki Eye Clinic, Aichi, Japan Purpose: To report the findings in three cases in which the average foveal thickness was increased after a thin epiretinal membrane (ERM) was removed by vitrectomy with internal limiting membrane (ILM) peeling.Methods: The foveal contour was normal preoperatively in all eyes. All cases underwent successful phacovitrectomy with ILM peeling for a thin ERM. The optical coherence tomography (OCT) images were examined before and after the surgery. The changes in the average foveal (1 mm) thickness and the foveal areas within 500 µm from the foveal center were measured. The postoperative changes in the inner and outer retinal areas determined from the cross-sectional OCT images were analyzed.Results: The average foveal thickness and the inner and outer foveal areas increased significantly after the surgery in each of the three cases. The percentage increase in the average foveal thickness relative to the baseline thickness was 26% in Case 1, 29% in Case 2, and 31% in Case 3. The percentage increase in the foveal inner retinal area was 71% in Case 1, 113% in Case 2, and 110% in Case 3, and the percentage increase in foveal outer retinal area was 8% in Case 1, 13% in Case 2, and 18% in Case 3.Conclusion: The increase in the average foveal thickness and the inner and outer foveal areas suggests that a centripetal movement of the inner and outer retinal layers toward the foveal center probably occurred due to the ILM peeling. Keywords: internal limiting membrane, optical coherence tomography, average foveal thickness, epiretinal membrane, vitrectomy

Kazuyuki Kumagai,1 Akinori Uemura,2 Mariko Furukawa,1 Tetsuyuki Suetsugu,1 Nobuchika Ogino3 1Department of Ophthalmology, Kami-iida Daiichi General Hospital, Aichi, 2Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, 3Department of Ophthalmology, Nishigaki Eye Clinic, Aichi, Japan Purpose: To report a patient whose foveal avascular zone (FAZ) decreased after vitrectomy with internal limiting membrane (ILM) peeling.Methods: A 58-year-old woman underwent successful phacovitrectomy with ILM peeling for a thin epiretinal membrane in an eye with a normal foveal contour. Optical coherence tomography angiographic en face images of the 3 mm×3 mm superficial and deep inner retinal vascular plexuses were examined preoperatively, and on days 1, 2, 9, and 37 postoperatively. The changes in the FAZ areas and the thicknesses of the parafoveal retinal layers at 500 μm from the foveal center were assessed in the vertical and horizontal B-scan images.Results: The areas of the superficial and deep FAZ decreased after the surgery. The course of the postoperative decrease of the FAZ area in the superficial plexus can be fit by a hyperbolic curve (R2=0.993). An increase in the thicknesses of the retinal nerve fiber layer, ganglion cell–inner plexiform layer, and inner nuclear layer was observed at all times postoperatively.Conclusions: We observed one case that the FAZ area decreased and the parafoveal inner retinal thickness increased after the vitrectomy with ILM peeling. The decrease in the FAZ area suggests that a centripetal movement of the inner retinal layer is probably due to the ILM peeling. Keywords: internal limiting membrane, optical coherence tomography angiography, foveal avascular zone

Takanori Mizoguchi,1 Shiro Nishigaki,2 Tomoki Sato,3 Harumi Wakiyama,4 Nobuchika Ogino2 1Mizoguchi Eye Clinic, Ophthalmology, Sasebo, 2Nishigaki Eye Clinic, Ophthalmology, Nagoya, 3Sato Eye Clinic, Ophthalmology, Arao, 4Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan Background: The purpose of this study was to determine outcomes when using Trabectome surgery and to evaluate factors associated with its effects in primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). Methods: This was a prospective, non-randomized, observational, comparative cohort study in which Trabectome surgery was used alone in patients with POAG or EXG. Trabectome surgery was considered to have failed when at least one of the following three criteria was fulfilled: intraocular pressure (IOP) ≥21 mmHg and a

Takanori Mizoguchi,1 Mineo Ozaki,2,3 Harumi Wakiyama,1,4 Nobuchika Ogino1,51Mizoguchi Eye Clinic, Nagasaki, Japan; 2Ozaki Eye Clinic Miyazaki, Japan; 3Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; 4The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan; 5Nishigaki Eye Clinic, Nagoya, JapanPurpose: To determine the prevalence of plateau iris in Japanese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and analyze the biometric parameters in patients with plateau iris using ultrasound biomicroscopy (UBM).Methods: In this cross-sectional observational study, subjects aged >50 years with PAC and PACG who had previously undergone a patent laser peripheral iridotomy underwent UBM in one eye. UBM images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least two quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. A-scan biometry was used to measure anterior segment parameters.Results: Ninety-one subjects with PAC (58 subjects) or PACG (33 subjects) and 68 normal controls were recruited. The mean (standard deviation) ages of PAC and PACG patients and normal controls were 73.5 (6.2) and 72.6 (7.3), respectively. Based on UBM criteria, plateau iris was found in 16 eyes (17.6%) of 91 eyes. In these 16 eyes, quadrant-wise analysis showed ten eyes (62.5%) had plateau iris in two quadrants; four eyes (25%) had plateau iris in three quadrants; and two eyes (12.5%) had plateau iris in four quadrants. Anterior chamber depth, lens thickness, axial length, lens position, and relative lens position were not statistically significant between the group having plateau iris and that not having plateau iris, respectively.Conclusion: Approximately 20% of Japanese subjects with PAC and PACG with a patent laser peripheral iridotomy were found to have plateau iris on UBM. No morphological difference was noted in the anterior segment of the eye between those with or without plateau iris.Keywords: ultrasound biomicroscopy, biometric parameters of anterior segment, plateau iris, angle closure

Takanori Mizoguchi,1 Mineo Ozaki,2,3 Harumi Wakiyama,1,4 Nobuchika Ogino1,5 1Mizoguchi Eye Clinic, Sasebo, Japan; 2Ozaki Eye Clinic, Miyazaki, Japan; 3Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; 4Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan; 5Nishigaki Eye Clinic, Nagoya, Japan Purpose: To investigate the relation between the quantitative iris parameters and iridotrabecular contact (ITC) in patients with primary angle-closure (PAC) and PAC glaucoma (PACG). Materials and methods: PAC and PACG with laser peripheral iridotomy were recruited prospectively. Anterior-segment optical coherence tomography (ASOCT) was performed under light and dark conditions, and scans were taken along the vertical and horizontal axes. Iris thickness at 500 µm (IT500) and 750 µm (IT750) from the scleral spur, maximal iris thickness (MIT), and cross sections of the iris area (I-Area) were measured by using software. ITC was defined by the ASOCT as the contact between the peripheral iris and angle wall anterior to the scleral spur. The ITC+ and ITC- groups were defined as eyes that had ITC in two or more quadrants and in no or one quadrant, respectively. Results: A total of 79 eyes of 60 patients (consisting of 48 PAC and 31 PACG) were recruited. The prevalence of superior, inferior, temporal, and nasal ITC was 44 eyes (55.7%), 48 eyes (60.8%), 18 eyes (22.8%), and 16 eyes (20.2%), respectively. These iris parameters of the inferior quadrant, which had the highest prevalence of all the quadrants, were used for the analysis. After adjusting for age, sex, pupil size, and central anterior chamber depth, mean values of IT500 and IT750 were significantly greater in the ITC+ group than the ITC- group (P

Kazuyuki Kumagai,1 Masanori Hangai,2 Mariko Furukawa,1 Eric Larson,3 Nobuchika Ogino4 1Department of Ophthalmology, Kami-iida First General Hospital, Nagoya, Japan; 2Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan; 3Miyazaki Prefectural Nursing University, Miyazaki, Japan; 4Nishigaki Eye Clinic, Nagoya, Japan Purpose: To show a case in which the shape of the fovea changed after an asymptomatic macular posterior vitreous detachment (PVD). Methods: The foveal shape was determined from the spectral-domain optical coherence tomography (OCT) images before and after a spontaneous macular PVD. Results: A 66-year-old man with a unilateral macular hole in the right eye presented with a perifoveal PVD in the asymptomatic left eye. One year later, the left eye developed a macular PVD, and OCT measurements showed a 16.7% decrease in the central foveal thickness, and increases in the pit depth by 20.5%, foveola diameter by 14.7%, and pit volume by 19.4%. The thicknesses of the macular subfields of the Early Treatment Diabetic Retinopathy Study were decreased by 13.0% in the central subfield and by 1.4%–6.6% in the other subfields. Conclusion: The deepening and widening of the fovea after a macular PVD indicate that a PVD can alter the shape of the fovea. Keywords: posterior vitreous detachment, spectral-domain optical coherence tomography, foveal pit, macular hole

Kazuyuki Kumagai1, Nobuchika Ogino1, Mariko Furukawa2, Masanori Hangai3, Shigeyasu Kazama1, Shirou Nishigaki4, Eric Larson51Shinjo Ophthalmologic Institute, Miyazaki, 2Department of Ophthalmology, Kami-iida First General Hospital, Nagoya, 3Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, 4Nishigaki Eye Clinic, Nagoya, 5Miyazaki Prefectural Nursing University, Miyazaki, JapanPurpose: To determine the retinal thickness (RT), after vitrectomy with internal limiting membrane (ILM) peeling, for an idiopathic macular hole (MH) or an epiretinal membrane (ERM). Also, to investigate the effect of a dissociated optic nerve fiber layer (DONFL) appearance on RT.Methods: A non-randomized, retrospective chart review was performed for 159 patients who had successful closure of a MH, with (n = 148), or without (n = 11), ILM peeling. Also studied were 117 patients who had successful removal of an ERM, with (n = 104), or without (n = 13), ILM peeling. The RT of the nine Early Treatment Diabetic Retinopathy Study areas was measured by spectral domain optical coherence tomography (SD-OCT). In the MH-with-ILM peeling and ERM-with-ILM peeling groups, the RT of the operated eyes was compared to the corresponding areas of normal fellow eyes. The inner temporal/inner nasal ratio (TNR) was used to assess the effect of ILM peeling on RT. The effects of DONFL appearance on RT were evaluated in only the MH-with-ILM peeling group.Results: In the MH-with-ILM peeling group, the central, inner nasal, and outer nasal areas of the retina of operated eyes were significantly thicker than the corresponding areas of normal fellow eyes. In addition, the inner temporal, outer temporal, and inner superior retina was significantly thinner than in the corresponding areas of normal fellow eyes. Similar findings were observed regardless of the presence of a DONFL appearance. In the ERM-with-ILM peeling group, the retina of operated eyes was significantly thicker in all areas, except the inner and outer temporal areas. In the MH-with-ILM peeling group, the TNR was 0.86 in operated eyes, and 0.96 in fellow eyes (P < 0.001). In the ERM-with-ILM peeling group, the TNR was 0.84 in operated eyes, and 0.95 in fellow eyes (P < 0.001). TNR in operated eyes of the MH-without-ILM peeling group was 0.98, which was significantly greater than that of the MH-with-ILM peeling group (P < 0.001). TNR in the operated eyes of the ERM-without-ILM peeling group was 0.98, which was significantly greater than that of ERM-with-ILM peeling group (P < 0.001).Conclusion: The thinning of the temporal retina and thickening of the nasal retina after ILM peeling does not appear to be disease-specific. In addition, changes in RT after ILM peeling are not related to the presence of a DONFL appearance.Keywords: epiretinal membrane, macular hole, optical coherence tomography, retinal thickness, internal limiting membrane

Takanori Mizoguchi1, Mineo Ozaki2, Harumi Wakiyama1,3, Nobuchika Ogino11Mizoguchi Eye Clinic, Sasebo, 2Ozaki Eye Clinic and Dept of Opthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, 3The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, JapanPurpose: To evaluate the intraocular pressure (IOP)-lowering effect of adding dorzolamide 1.0%/timolol 0.5% fixed combination (DTFC) to prostaglandin analogs (PGAs) as monotherapy in patients with normal tension glaucoma.Methods: A prospective, clinical, case-controlled study of patients with normal tension glaucoma. Patients had been on a once-daily night dose of prostaglandins (PGs) as monotherapy and then received DTFC added to PGs for 8 weeks. The IOP was measured at 9 am, week 0 (baseline), week 4, and week 8.Results: The baseline IOP of 40 patients who had previously been treated by prostaglandin monotherapy was 15.6 ± 2.0 mmHg at baseline. The IOPs at 4 and 8 weeks after adding DTFC to PGs were 13.5 ± 2.1 mmHg and 13.7 ± 2.2 mmHg, respectively. Significant decrease of the IOP was observed at each time point of measurement as compared with the baseline IOP before adding DTFC (P = 0.01). The percent IOP reduction from the baseline IOP at week 4 and week 8 was 13.5% ± 12.3% and 11.7% ± 13.1%, respectively. The percentage of patients who achieved 10% or more IOP reduction from the baseline IOP at week 8 was 62.5%. The baseline IOP was significantly correlated with the percent IOP reduction at week 8 (P = 0.03, r = 0.34).Conclusion: DTFC therapy added to PGAs as glaucoma monotherapy is effective in patients with normal tension glaucoma.Keywords: IOP-lowering effect, prostaglandin, dorzolamide 1%/timolol 0.5% fixed combination, fixed combination, normal tension glaucoma

Subretinal strands in proliferative vitreoretinopathy removed during vitreous surgery in ten cases were studied histologically; tissue culture was taken from five of the ten cases to obtain more material for investigation. Tissue culture was successful in all five cases. The cultured tissue just next to the original strand preserved the characteristics of the original tissue, whereas the portion distal from the original strand did not. Definite and/or suspected retinal pigment epithelial cells (RPE) were found in seven of ten original strands and four of five samples of cultured material. RPE were considered to be a predominant component of subretinal strands. [ABSTRACT FROM AUTHOR]